- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,397.08 / $4,689.50 / $10,736.52
| Facility | | $1,397.08 | $4,689.50 | $10,736.52 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $7,199.11 / $7,199.11 / $7,199.11
| Facility | 22 | $7,199.11 | $7,199.11 | $7,199.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,247.00 / $10,850.30 / $24,835.49
| Facility | | $4,247.00 | $10,850.30 | $24,835.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $1,346.11
| Facility | | $895.00 | $950.00 | $1,346.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $133.62 / $133.62 / $133.62
| Facility | AS | $133.62 | $133.62 | $133.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $6,231.00 / $11,869.99
| Facility | | $2,912.00 | $6,231.00 | $11,869.99 |